Annelise Chmelik
April 24, 2014
KNH 413
Diet Instruction: Bland Diet
1. Description of Patient and Diagnosis
a. Patient:
Client name: Anthony Cicero
DOB: 2/15
Age: 37
Sex: Male
Education: College Degree, Law Degree
Occupation: Lawyer
Hours of work: 70 hours/week
Household members: Lives with his wife Rosanna age 34, son Michael age 7, and
daughter Francesca age 3.
Ethnic background: Italian
Religious affiliation: Catholic
Referring physician: P. A. Rocco, MD
Chief complaint:
“For about 6 weeks now I have had horrible abdominal pain and a pretty consistent
burning sensation. My symptoms worsen every time I eat food, and are even worse
at night. My wife said that I am not eating as much as I used to, and I tell her it is
because I do not have much of an appetite.“
Patient history:
Mr. Cicero is a 37-yo male lawyer, who recently was assigned a very important case.
He has been working at the office at least 70 hours a week, and has been
significantly stressed. A majority of his meals have been fast food because he does
not have time to sit and eat a home cooked meal. Therefore, he has been picking up
McDonalds or Chipotle on a regular basis since those restaurants are down the block
from the firm he works at. Mrs. Cicero said that whenever he gets a chance to relax,
he indulges in a Scotch, sometimes two or three a night. Mrs. Cicero also noted that
her husband has lost about 7 pounds in the last month.
Onset of disease: 6 weeks
Meds: Aspirin for occasional backaches
Smoker: Yes. ½ pack per day
Anthropometric Data:
Height: 5’10”
Weight: 205 lbs
Vitals: Temp 97.6˚F, BP 135/90 mm Hg
Nutrition Hx:
General: Appetite has been poor.
Usual dietary intake:
Breakfast:
Black coffee – 2 cups
McDonalds Breakfast Burrito
Lunch:
Chipotle Burrito Bowl with white rice, steak, tomato salsa, corn salsa,
extra hot salsa, sour cream, cheese, and lettuce
Tortilla chips and guacamole
12 oz. Coca-Cola
PM snack:
Black coffee – 2 cups
Dinner:
Spaghetti and Meatballs with a vodka cream sauce
Side salad with vinagrette dressing
Scotch on the rocks with lemon
HS snack:
Slice of chocolate cake
24-hr recall:
Breakfast:
Black coffee – 2 cups
McDonalds Egg McMuffin
McDonalds Hasbrown
Lunch:
No appetite/time for lunch, just a 12 oz. Coca-Cola
PM Snack:
Black coffee
Dinner:
1 piece of Spicy Italian Sausage
Garlic bread
HS Snack:
2 glasses of Scotch on the rocks with lemon
Food allergies/intolerances/aversions (specify): None
Previous MNT? No
Food purchase/preparation: Self and wife
Vit/min intake: None
Diet order: Bland diet
Tx plan:
Antibiotic to kill H. pylori
Proton Pump Inhibitor (PPI): suppresses acid production by halting the mechanism
that pumps acid into the stomach
Nutrition consultation for education on Bland Diet, which will assist in the reduction
or elimination of symptoms
b. Diagnosis:
After Dr. Rocco listened to his symptoms, stress, and intake of caffeine, alcohol,
cigarettes, and high-fat foods, the physician decided to perform an endoscopy to
determine if an ulcer was present. The endoscopy revealed a peptic ulcer. The
physician also conducted a urea breath test to confirm the presence of H. pylori.
Peptic ulcer disease involves ulcerations of the mucosa of the gastrointestinal tract
and can occur in the esophagus, stomach, duodenum, and jejunum. This break in the
mucosa results in a crater surrounded by an acute and chronic inflammatory cell
infiltrate.
2. Discussion of Disease:
a. Etiology:
An ulceration can develop in the following conditions:
 The stomach produces excess amounts of pepsin and acid
 The lining of the stomach or duodenum is impaired and is more
susceptible to damage from gastric acid and pepsin
Factors that may affect the mucosal integrity include the following:
 Helicobacter pylori infection: Helicobacter pylori bacteria commonly live
in the mucous layer that covers and protects tissues that line the
stomach and small intestine. Often, H. pylori causes no problems, but it
can cause inflammation of the stomach’s inner layer, producing an ulcer
 Aspirin: aspirin or certain over-the-counter and prescription pain
medications can irritate or inflame the lining of your stomach and small
intestine.
 Nonsteroidal, anti-inflammatory drugs
 Alcohol: alcohol can irritate and erode the mucous lining of your
stomach, and it increases the amount of stomach acid that is produced.
 Steroids
Factors that decrease the blood supply to the gastric or duodenal mucosa
include the following:
 Smoking
 Stress
 Injury
Factors that increase acid secretion include the following:
 Foods:
o Pepper
o Alcohol
o Caffeine
 Rapid gastric emptying
 Stress
 Other conditions such as Zollinger-Ellison syndrome
b. Diagnostic Measures

Tests for H. pylori:
o Blood: a blood sample is taken from the patient’s vein and tested
for H. pylori antibodies
o Urea Breath Test: the patient swallows a capsule, liquid, or
pudding that contains urea “labeled” with a special carbon atom.
After a few minutes, the patient breathes into a container,



exhaling carbon dioxide. If the carbon atom is found in the
exhaled breath, H. pylori is present, as this bacterium contains
large amounts of urease, a chemical that breaks urea down into
carbon dioxide
o Stool: the patient provides a stool sample, which is tested for H.
pylori antigens
Endoscopy of the gastrointestinal tract
o During an endoscopy, the physician passes a hollow tube
equipped with a lens down the throat and into the esophagus,
stomach, and small intestine. Using the endoscope, the physician
will look for ulcers. If the doctor detects an ulcer, small tissue
samples may be removed for examination in a lab. A biopsy can
also identify the presence of H. pylori in the stomach lining
o A doctor is more likely to recommend endoscopy if the patient is
older, having signs of bleeding, or have experienced recent
weight loss or difficulty eating and swallowing.
X-ray of upper digestive system
o This procedure is sometimes called a barium swallow or upper
gastrointestinal series. This series of X-rays creates images of
your esophagus, stomach, and small intestine. During the X-ray,
the patient swallows a white liquid, containing barium, which
coats the digestive tract and makes an ulcer more visible.
Tests to determine contributions from other conditions that may
contribute to hypersecretion (Zollinger-Ellison Syndrome) include the
following:
o Serum gastrin
o Secretin stimulation test
c. Treatment:
i. Medical, surgical, and/or psychological treatment
The treatment for peptic ulcers depends on the cause. Treatments can
include:
 Antibiotic medications to eliminate H. pylori: if H. pylori is found
within the digestive tract, the physician may recommend a
combination of antibiotics to kill the bacterium
 Medications that block acid production and promote healing: proton
pump inhibitors reduce stomach acid by blocking the action of the
parts of cells that produce acid. These drugs include the prescription
and over-the-counter medications omeprazole (Prilosec),
lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole
(Nexium), and pantoprazole (Protonix).
 Medications to reduce acid production: Acid blockers – also called
histamine (H-2) blockers – reduce the amount of stomach acid
released into your digestive tract, which relieves ulcer pain and
encourages healing. Available by prescription or over-the-counter,


acid blockers include the medications ranitidine (Zantac),
famotidine (Pepcid), cimetidine (Tagamet), and nizatidine (Axid).
Antacids that neutralize stomach acid: antacids neutralize existing
stomach acid and can provide rapid pain relief, but generally are not
used to heal the ulcer.
Medications that protect the lining of your stomach and small
intestine: in some cases, the physician may prescribe medications
called cytoprotective agents that help protect the tissues that line
your stomach and small intestine. Options include the prescription
medications sucralfate (Carafate) and misoprostol (Cytotec).
Another nonprescription cytoprotective agent is bismuth
subsalicylate (Pepto-Bismol)
ii. Medical Nutrition Therapy treatment for client
Nutrition therapy for peptic ulcer disease calls for the following:
 Optimize nutritional intake to correct any deficiencies and to meet
nutrition needs
 Avoid foods that potentially increase gastric acid secretion or can
damage the gastric mucosa
o Alcohol
o Pepper
o Caffeine
o Tea
o Coffee (including non-caffeinated)
o Chocolate
 Identify foods that directly irritate the gastric mucosa or are not
individually tolerated
 Avoid eating at least 2 hours before bedtime
Bland Diet:
 A bland diet is made up of foods that are soft, not very spicy, and low
in fiber
 Alcoholic and caffeinated beverages should be avoided
 Smoking should be ceased
iii. Prognosis
Treatment for peptic ulcers is often successful, leading to ulcer healing.
Along with the medication to kill the H. Pylori, the Bland diet will eliminate
any stimulating, irritating, and seasoned products from the diet. It is crucial
to take the prescribed medications according to the directions, cease
regular tobacco use, and discontinue use of pain relievers that increase the
risk of ulcers to ensure that the ulcer heals properly.
3. Client Instruction Materials
The purpose of a bland diet is to alleviate the gastric distress the patient is having.
Therefore, the foods included are limited to non-stimulating, non-irritating and
mildly seasoned products. This diet should be well balanced and individualized
according to the patient’s appetite and food tolerance. With time and recovery, the
patient may be able to expand this diet to their individual tolerances.
The following recommendations may help provide some relief:
 Avoid alcohol, cigarette smoking, aspirin, and other non-steroidal antiinflammatory agents
 Avoid frequent meals and or bedtime snacks to prevent increased acid
secretion, unless you note you gain relief from certain foods.
 Foods and seasonings that stimulate gastric acid secretion such as caffeine,
black pepper, garlic, cloves, and chili powder should be limited
 Do not eat within two hours of bedtime,
 Omit any particular foods that cause discomfort.
 Eat a well-balanced diet that includes a variety of foods
 Cook by baking, boiling, broiling, roasting, stewing, microwaving or
creaming. Avoid frying
Usual dietary intake:
Breakfast:
Lunch:
PM snack:
Dinner:
HS snack:
Black coffee – 2 cups
McDonalds Breakfast Burrito
Chipotle Burrito Bowl with white rice, steak, tomato salsa, corn salsa,
extra hot salsa, sour cream, cheese, and lettuce
Tortilla chips and guacamole
12 oz. Coca-Cola
Black coffee – 2 cups
Spaghetti and Meatballs with a vodka cream sauce
Side salad with vinaigrette dressing
Scotch on the rocks with lemon
Slice of chocolate cake
24-hr recall:
Breakfast:
Lunch:
PM Snack:
Dinner:
HS Snack:
Black coffee – 2 cups
McDonalds Egg McMuffin
McDonalds Hashbrown
No appetite/time for lunch, just a 12 oz. Coca-Cola
Black coffee
1 piece of Spicy Italian Sausage
Garlic bread
2 glasses of Scotch on the rocks with lemon
Sample Meal Plan:
Meal
Breakfast
Lunch
PM Snack
Dinner
HS Snack
Food Choices
¾ cup of oatmeal
½ cup of canned peaches
8 oz skim milk
Chipotle Burrito Bowl with white rice,
chicken, cheese, and lettuce
12 oz. Orange Juice
Creamy peanut butter and crackers
made with refined white flour
½ cup Spaghetti with red sauce, grilled
chicken
½ cup of cooked green beans
½ cup of applesauce
8 oz. skim milk
8 oz. water
------
Client Instructions
Breakfast:
Exchange McDonalds Breakfast Burrito for oatmeal
Exchange black coffee for skim milk
Include canned peaches
Lunch:
Eliminate tomato, corn, and hot salsa
Eliminate sour cream because of high fat content
Eliminate the guacamole
Eliminate Coca Cola for orange juice
PM Snack:
Eliminate coffee for water
Include creamy peanut butter and crackers
Dinner:
Exchange spicy/processed meats, e.g. sausage for grilled chicken
Exchange vodka sauce for red sauce
Exchange side salad for cooked green beans
Include apple sauce
Eliminate garlic bread
Exchange scotch for skim milk
HS Snack:
Eliminate chocolate cake
Eliminate scotch on the rocks
**Client should not consume any food stuff 2 hours prior to bed time
References:
Arizona Diet Manual. (1998). Bland Diet. Retrieved from
http://web.squ.edu.om/medlib/med_cd/e_cds/Griffith's%20Instructions%20Patients/pdf/Pg537.pdf
Dempsey DT & Harbison Sp. (2005). Peptic Ulcer Disease. 42(6): 346-454.
http://www.ncbi.nlm.nih.gov/pubmed/15988415?dopt=Abstract
FDA Diet Manual. (2014). Bland Diet. Retrieved from
http://www.medfusion.net/templates/groups/2328/3078/Bland%20Diet.pdf
Mayo Clinic. (2014). Peptic Ulcer. Retrieved from
http://www.mayoclinic.org/diseases-conditions/pepticulcer/basics/prevention/con-20028643
MedlinePlus. (2014). Bland Diet. Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000068.htm
Myrtue Medical Center. (2008). Bland Diet Peptic Ulcer. Retrieved from
http://myrtuemedical.org/assets/pdf/dietary/bland-diet-for-peptic-ulcer.pdf
Nutrition Care Manual. (2014). Peptic Ulcer. Retrieved from
http://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5522&lv2
=145083&ncm_toc_id=20009&ncm_heading=Nutrition%20Care
UC Davis. (2014). Nutritional Management of Gastrointestinal Diseases. Retrieved
from
http://nutrition.vetmed.ucdavis.edu/client_info_sheets/gastrointestinal_disease.cf
m
U.S. Department of Health and Human Services. (2014). H. pylori and Peptic Ulcers.
Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/index.aspx
University of Maryland Medical Center. (2014). Gastritis. Retrieved from
http://umm.edu/health/medical/altmed/condition/gastritis